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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. ADJ10256108, ADJ10255968, ADJ10256212, ADJ10256223, ADJ10489875
Regular
Sep 23, 2022

JOSEPH RYAN vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, STATE COMPENSATION INSURANCE FUND

The Appeals Board affirmed the finding of permanent and total disability for the applicant, Joseph Ryan, stemming from industrial injuries sustained while employed as a correctional captain. However, the Board remanded the matter for further proceedings to specifically address apportionment of the permanent disability under Labor Code section 4663, considering the Agreed Medical Evaluator's opinion on pre-existing spinal disease. The Board found that the applicant's specific and cumulative trauma injuries to his spine resulted in intertwined disabilities, justifying a combined award, but that Dr. Hasday's apportionment findings require further development and determination at the trial level.

Workers' Compensation Appeals BoardJoseph RyanCalifornia Department of CorrectionsLegally UninsuredState Compensation Insurance FundADJ10256108ADJ10255968ADJ10256212ADJ10256223ADJ10489875
References
Case No. ADJ6772495; ADJ7394371; ADJ11006855; ADJ7648530; ADJ6788916
Regular
Oct 22, 2025

Amy Stacy Bosko, Elsie Gonzales, Marilyn Lonzanida, Ray Dunhams, Kuchita Hawthorne vs. Learning Care Group, Coca Cola Enterprises, IHSS Solano County, AC Transit, UPS

Applicants Amy Stacy Bosko, Elsie Gonzales, Marilyn Lonzanida, Ray Dunhams, and Kuchita Hawthorne filed a joint Petition for Removal challenging a Workers' Compensation Judge's (WCJ) July 13, 2022 orders. These orders denied their petitions to set their cases on a non-OD-Legal block day and to terminate all OD-Legal Block days at the Oakland District Office, citing the WCJ's lack of authority. The Appeals Board, after reviewing the petition and the WCJ's report, denied the Petition for Removal. The Board determined that removal, an extraordinary remedy, was not warranted as the petitioners failed to show substantial prejudice or irreparable harm, nor that reconsideration would be an inadequate remedy.

Petition for RemovalWCABWCJOD-Legal Block DayScheduling AuthorityExtraordinary RemedySubstantial PrejudiceIrreparable HarmReconsiderationAppeals Board
References
Case No. ADJ2211743 (SBR 0330510)
Regular
Jul 19, 2011

LAURA GIBSON vs. FOREST HOME, INCORPORATED, CHURCH MUTUAL INSURANCE

The Workers' Compensation Appeals Board denied reconsideration of a lien claimant's petition regarding reimbursement for medical treatment. Although the petition was not acted upon within the statutory 60-day period, the Board considered it on its merits due to circumstances beyond the claimant's control. The WCJ's report, which was adopted by the Board, found that the lien claimant failed to meet the burden of proof for treatment beyond a single epidural injection. The Board determined that only charges attributable to a single epidural procedure were reasonable and necessary, excluding other procedures like facet blocks and manipulation under anesthesia.

WORKERS' COMPENSATION APPEALS BOARDLAURA GIBSONFOREST HOMEINCORPORATEDCHURCH MUTUAL INSURANCEORDER DENYING RECONSIDERATIONPetition for Reconsiderationlien claimantdue processWCJ report
References
Case No. ADJ6639764
Regular
Sep 23, 2010

DENNIS MUSKRAT vs. CALIFORNIA MEN'S COLONY, SCIF STATE EMPLOYEES OXNARD

The Workers' Compensation Appeals Board granted reconsideration to eliminate a 25% penalty previously awarded. The penalty was based on the employer's denial of medial branch blocks, but the Board found the employer's request for clarification from the Agreed Medical Evaluator was reasonable. The AME had failed to cite evidence supporting the treatment recommendation, and the employer's inquiry was justified given this lack of basis. Therefore, the penalty was rescinded, and the employer was ordered to provide the necessary medical treatment.

Workers' Compensation Appeals BoardIndustrial InjuryLumbar SpineTemporary DisabilityMedical Branch BlocksUtilization ReviewAgreed Medical Evaluator (AME)Labor Code Section 5814PenaltyUnreasonable Delay
References
Case No. ADJ8115084
Regular
Jun 02, 2014

MARY HAYWORTH vs. KCI HOLDINGS USA, INC., FIDELITY AND GUARANTY INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration, rescinding a prior finding that the applicant failed to establish a plainly erroneous fact in an Independent Medical Review (IMR) determination. The Board found the IMR decision was based on a plainly erroneous mistake of fact because it evaluated a request for dorsal medial branch block injections as though it were a request for facet injections, which are different procedures. Consequently, the medical treatment dispute is remanded to the Administrative Director for review by a different independent review organization or reviewer.

Workers' Compensation Appeals BoardIndependent Medical ReviewLabor Code Section 4610.5Plainly Erroneous Finding of FactMedical Treatment DisputeUtilization ReviewAdministrative DirectorDorsal Medial Branch BlockFacet InjectionsMTUS Guidelines
References
Case No. SRO 0121152
Regular
Dec 12, 2007

GINGER DUNLAP-FENTON vs. EEL RIVER SAWMILLS, SELF-INSURERS' SECURITY FUND

This case involved a defendant's petition for reconsideration of an award for an applicant's industrial neck injury. The appeals board granted reconsideration, amending the original award to reduce the permanent disability rating from 23% to 17% and adjusting the applicant's attorney fees. The board adopted the WCJ's report, which specified the revised permanent disability indemnity, the calculation of attorney fees on remaining temporary disability and self-procured medical expenses, and affirmed other aspects of the original award.

Workers Compensation Appeals BoardEel River SawmillsSelf-Insurers' Security Fundindustrial injuryblock stackerbankruptcytemporary total disabilitypermanent disabilityapportionmentself-procured medical treatment
References
Case No. VNO 497379
Regular
Dec 27, 2007

AGNES MERCADO vs. AMERICAN DAWN, INC., HIGHLANDS INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to correct errors in the original award to lien claimant S&B Surgery Center. The Board reduced the award for certain epidural injections and a lysis procedure based on corrected billing and relevance of the comparative study. Despite defendant's arguments, the Board affirmed the award of statutory interest on unpaid medical bills, finding the defendant failed to meet statutory requirements for contesting payment.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationFindings and AwardEpidural BlocksLumbar DiscographyCompromise and ReleaseLabor Code Section 4603.2Medical TreatmentInterest
References
Case No. ADJ7511306
Regular
Nov 10, 2010

RICHARD MILLER vs. MORROW MEADOWS NORTHERN CALIFORNIA AND TRAVELERS INSURANCE COMPANY

The Workers' Compensation Appeals Board denied reconsideration of an order that denied the defendant's request for credit against permanent disability for alleged overpayments of temporary disability. The Board adopted the arbitrator's report, finding that the defendant failed to prove they authorized the recommended medical treatment. Absent authorization of specific treatments, the applicant's failure to attend appointments was immaterial, and a credit was not warranted.

Workers' Compensation Appeals BoardReconsideration DeniedTemporary DisabilityPermanent DisabilityCredit for OverpaymentsAuthorized Medical TreatmentAgreed Medical Evaluator (AME)Primary Treating PhysicianEpidural BlocksMRI Scan
References
Case No. ADJ7697380
Regular
Jan 26, 2017

ADWARD MARTINEZ vs. COUNTY OF ORANGE

This case involves Edward Martinez, a former Welfare Fraud Investigator, who sustained a cumulative trauma injury to his right hand, wrist, and shoulder. The Workers' Compensation Appeals Board granted reconsideration, affirming the finding that Martinez did not sustain industrial injury to his heart. However, the Board overturned the trial judge's decision on occupational classification, determining that Martinez's duties as a welfare fraud investigator, which included field investigations, interviews, carrying a firearm, and making arrests, qualified him for the higher occupational group number 490 (police officer). Consequently, his permanent disability rating was increased to 24%.

Occupational group numberAgreed Medical Examiner (AME)Petition for ReconsiderationPermanent disability ratingCumulative trauma injuryInternal medicineHypertensionAggravation of diabetesAtherosclerotic diseaseBifascicular block
References
Case No. ADJ6989761
Regular
Sep 30, 2013

ELVIN SALGUERO vs. CHARLES GEMEINER CABINETS, INSURANCE COMPANY OF THE WEST

This case involves an applicant seeking reconsideration of a denial for 24/7 home care. The applicant argues the denial was an abuse of discretion, as medical evidence supported the need for such care due to suicidal ideation and depression. The Workers' Compensation Appeals Board denied the petition, adopting the judge's report which found no support for 24/7 home care in relevant treatment guidelines. The judge concluded that the applicant failed to prove the requested care was reasonable and necessary beyond the requirements of existing guidelines.

WCABPetition for ReconsiderationHand Surgery EvaluationStellate Block ProceduresHome CarePsychiatric TechnicianLicensed Vocational NurseSuicidal IdeationPsychiatric HospitalizationLabor Code Section 4600(b)
References
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